Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2022; 10(15): 4856-4877
Published online May 26, 2022. doi: 10.12998/wjcc.v10.i15.4856
Outcome of the efficacy of Chinese herbal medicine for functional constipation: A systematic review and meta-analysis
Zipan Lyu, Yibo Fan, Yang Bai, Tao Liu, Linda LD Zhong, Hui-Feng Liang
Zipan Lyu, Yibo Fan, Teaching and Research Division, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR 99977, China
Yang Bai, Department of Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
Tao Liu, Department of Digestive Endoscope Center, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
Linda LD Zhong, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong 999077, China
Hui-Feng Liang, The Institute for Science, Technology and Humanities, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
Author contributions: Lyu Z and Bai Y contributed toward the concept and data analysis; Lyu Z and Fan Y contributed toward manuscript writing; Zhong LL, Liu T, and Liang HF contributed toward concept and manuscript review; In addition, Lyu Z, Fan Y and Bai Y made equal contributions; Zhong LL and Liang HF should be considered as co corresponding authors.
Supported by the Hong Kong Chinese Medicine Development Fund (19B2/057A). The fund agency has no role in conducting the research.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hui-Feng Liang, MD, PhD, Shanghai University of Traditional Chinese Medicine, No. 1200 Cai Lun Road, Shanghai 201203, China. lianghuifeng5418@shutcm.edu.cn
Received: May 31, 2021
Peer-review started: May 31, 2021
First decision: June 25, 2021
Revised: July 14, 2021
Accepted: April 2, 2022
Article in press: April 2, 2022
Published online: May 26, 2022
Processing time: 358 Days and 8.1 Hours
Abstract
BACKGROUND

Functional constipation (FC) is a common and chronic gastrointestinal disease and its treatment remains challenging.

AIM

To evaluate the efficacy and safety of Chinese herbal medicine (CHM) on efficacy rate, global symptoms, bowel movements and the Bristol Stool Scale score in patients with FC by summarizing current available randomized controlled trials (RCTs).

METHODS

RCTs with CHM to treat FC were identified by a systematic search of six databases from inception to October 20, 2020. Two independent reviewers assessed the quality of the included articles and extracted data. Meta-analyses were performed to odds ratio (OR), mean differences (MD) and 95% confidence interval (CI) using random-effects models. Subgroup analyses and sensitivity analyses were used to explore and interpret the sources of heterogeneity. The funnel plot, Begg’s test and Egger’s test were used to detect publication bias.

RESULTS

Ninety-seven studies involving 8693 patients were included in this work. CHM was significantly associated with a higher efficacy rate (OR: 3.62, 95%CI: 3.19-4.11, P < 0.00001) less severe global symptoms (OR: 4.03, 95%CI: 3.49-4.65, P < 0.00001) compared with control treatment, with the low heterogeneity between studies (I2 = 0%, P = 0.76). CHM was also associated with more frequent bowel movements (MD 0.83, 95%CI: 0.67-0.98, P < 0.00001), a lower score on the Bristol Stool Scale (OR: 1.63, 95%CI: 1.15-2.32, P < 0.006), and a not significant recurrence rate (OR: 0.47, 95%CI: 0.22-0.99, P = 0.05). No serious adverse effects of CHM were reported.

CONCLUSION

In this meta-analysis, we found that CHM may have potential benefits in increasing the number of bowel movements, improving stool characteristics and alleviating global symptoms in FC patients. However, a firm conclusion could not be reached because of the poor quality of the included trials. Further trials with higher quality are required.

Keywords: Functional constipation; Chinese herbal medicine; Efficacy; Systematic review; Meta-analysis

Core Tip: In this meta-analysis, we found that Chinese herbal medicine may have potential benefits in increasing the number of bowel movements, improving stool characteristics and alleviating global symptoms in functional constipation patients. However, a firm conclusion could not be reached because of the poor quality of the included trials. Further trials with higher quality are required.